USPSTF: Drug-Free Teens? Not Yet

by John Gever John Gever,Deputy Managing Editor, MedPage Today
March 10, 2014

There is currently no solid evidence showing that any doctor-led intervention is effective at preventing children and adolescents from using drugs other than tobacco, the U.S. Preventive Services Task Force found.

Task force members could find only six good- or fair-quality studies of behavioral interventions for primary care physicians aimed at promoting abstinence among youths 18 and younger, or at stopping or reducing drug use among those already experimenting with drugs at a level not rising to a formal substance use disorder, according to USPSTF chair Virginia Moyer, MD, MPH, of Baylor College of Medicine in Houston and the American Board of Pediatrics (AAP), and colleagues.

And those trials failed to find a significant benefit for any of the programs tested, they wrote in their final statement, published Monday in Annals of Internal Medicine, in which they granted an "I" for "insufficient evidence" to such interventions.

The review focused on all kinds of recreational psychoactive drugs, including alcohol, prescription medications, and illicit drugs such as marijuana and cocaine. The interventions had to be designed for delivery in primary care settings. It excluded treatments for substance use disorders, as well as programs to be delivered in schools or by parents.

Interventions covered in the review included:

Computer-based screening and education plus 2 to 3 minutes of advice from the patient's clinician

Interactive computer-based education

Live therapist-delivered education

At-home education for mothers and young teen daughters

Some of the reviewed studies included tobacco as a target drug, but adolescent tobacco use was the subject of a separate USPSTF review published last year.

USPSTF member Susan Curry, PhD, of the University of Iowa College of Public Health in Iowa City, told MedPage Today that the difference arose mainly from the dearth of high-quality studies examining programs targeting nontobacco drug use in youths.

She said the task force reviewed what there was to review. "Unfortunately, what this means is that there is a much more robust evidence base for tobacco than there is for drug and substance use in primary care settings with adolescents," she said.

But physicians need not just throw up their hands, Curry emphasized.

"When we issue an 'I' statement, it means there's insufficient evidence. It doesn't mean we are recommending against doing something," she explained.

"This is the opportunity and the time where our expertise and our clinical judgment become very important. We know the populations of patients that we're working with, we know the importance of engaging with our young patients, to talk with them about substance use, tobacco use, and alcohol use," Curry added.

Steven Matson, MD, of Nationwide Children’s Hospital in Columbus, Ohio, told MedPage Today in an email that he starts by pointing out to parents that they serve as role models.

"As a general pediatrician you help families understand that children pattern themselves after parents, so not smoking, not drinking to excess, and a mentality that not all mental hardship requires drug or medicinal intervention" help convey good messages to children, he said.

Matson said that it’s also important for doctors not to simply lecture kids about the evils of drugs. "Physicians need to concentrate on the health of the adolescent and not just come across as another adult telling them not to use drugs."

The task force statement noted that the group "recognizes that clinical decisions involve more considerations than evidence alone. Clinicians should understand the evidence but individualize decision-making to the specific patient or situation." It also pointed out that the AAP recommends that pediatricians perform screening and counseling regarding drug use; the American Academy of Family Physicians is now reviewing a recommendation on interventions.

"Obviously we hope that there will be more research done in the future so that we can get off the 'I' statement," Curry said.

Matson told MedPage Today that attention deficit-hyperactivity disorder should be one focus of such research, insofar as it is a known contributor to drug experimentation.

Also, he suggested, studies should examine whether availability of mental health services reduces unhealthy drug use, and what effect the marijuana legalization trend may have on teen use of the drug.

UPDATE: This article, originally published on March 10 at 17:46 EST, was updated with new material on March 11 at 11:17 EST.

This research was funded by the Agency for Healthcare Research and Quality.